Drug-induced pigmentation caused by minocycline may affect the skin, mucosal surfaces, teeth, tongue, sclera, bone, heart, thyroid, and other locations. Minocycline is a tetracycline-derived antibiotic with various uses, most notably as a second-line treatment for acne vulgaris. Hyperpigmentation may follow ingestion of 100-200 mg/day for 1-3 years, and incidence rates vary from 2.4%-14.8%. However, some studies have demonstrated the development of hyperpigmentation following small doses and short courses of minocycline.
The incidence seems highest in patients with conditions such as atopic dermatitis, acne vulgaris, rheumatoid arthritis, pemphigoid, and pemphigus.
Four types of hyperpigmentation have been described: types I–IV. Each type varies in distribution and histology. (For type details, refer to Look For section.)
Pediatric Patient Considerations: Children aged younger than 9 years should not be on medications from the tetracycline family of antibiotics.
Codes
ICD10CM: T50.995A – Adverse effect of other drugs, medicaments and biological substances, initial encounter
SNOMEDCT: 110284009 – Drug-induced pigmentation
Look For
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Differential Diagnosis & Pitfalls
Drug-induced pigmentation (antimalarials) – brown, gray-brown, blue-black, yellow, or yellow-green pigmentation may occur with use of more than 1 year; may affect the nail beds
Human immunodeficiency virus (HIV)-infected patients and AIDS patients on zidovudine may develop brown macules on the oral mucosa or lips and longitudinal brown bands on nails.
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
Patients with acne vulgaris or other conditions calling for an antibiotic may be treated with a tetracycline derivative called minocycline. Among its side effects are discoloration (hyperpigmentation) of skin. Other areas may be affected, such as your nails, teeth, mouth, tongue, or the whites of your eyes. The discoloration will be blue-gray or muddy brown.
Who’s At Risk
If you are taking the antibiotic minocycline, you may develop discoloration (hyperpigmentation) of skin or other areas, usually after 1-3 years. It has been known to occur with small doses for short-term use.
If you have been diagnosed with acne vulgaris, atopic dermatitis, pemphigoid, pemphigus, or rheumatoid arthritis, you may have a greater chance of having a hyperpigmentation reaction while taking minocycline.
Minocycline is not recommended for children younger than 9. If you are pregnant, you should know that your baby is at risk for developing permanent discoloration of teeth if you are on a long-term course of minocycline during pregnancy.
Signs & Symptoms
Watch for blue-gray or muddy brown areas of the skin (or fingernails, mouth, or eyes) or staining of teeth. Common locations are the face, arms, trunk, and legs.
Your doctor may note which type of skin pigmentation best matches your signs and symptoms, including: Type I – dirty-appearing discoloration of face, scars, or injury sites Type II – patches of discolored skin on legs and arms Type III – muddy brown discoloration on sun-exposed skin Type IV – discolored areas of scar tissue on your body
Self-Care Guidelines
Avoid exposure to sun or tanning lights. Report any and all drug-reactions to your primary care physician. Follow any dosing modifications or substitute medications prescribed by your doctor. If you choose to have laser treatment, your doctor will provide a self-care routine to follow as you heal.
When to Seek Medical Care
If you become pregnant, or if you notice discoloration or worsening of discoloration from minocycline, contact your doctor.
Pigmentation may take months to clear up after stopping use of this medication. If you notice that discoloration fails to clear up after stopping use of minocycline, contact your doctor.
Treatments
Your doctor may reduce dosage to minimum effective dosage, or discontinue minocycline use.
You will be checked for other adverse effects of the antibiotic, such as kidney dysfunction, dizziness, imbalance, vision changes, or superinfection.
Patient Information for Minocycline drug-induced pigmentation in Adult